Nazal Mark R, Parsa Ali, Martin Scott D
Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Orthop J Sports Med. 2019 Jun 27;7(6):2325967119854362. doi: 10.1177/2325967119854362. eCollection 2019 Jun.
The use of hip arthroscopic surgery in patients suffering from chronic hip pain after total hip arthroplasty (THA) has a limited presence in the literature, with most studies having limited follow-up.
The first goal of this study was to evaluate hip arthroscopic surgery in the diagnosis and management of patients with chronic hip pain after THA. The second goal was to describe a new cause of iliopsoas tendinopathy (IPT) involving disruption of the anterior capsule.
Case series; Level of evidence, 4.
We conducted a retrospective analysis with prospectively collected clinical outcomes of patients after THA who underwent hip arthroscopic surgery for chronic hip pain without an identifiable cause. The patients were at least 18 years old and had a minimum follow-up of 24 months.
The retrospective analysis found that hip arthroscopic surgery led to new diagnostic information in 8 patients (80%). Of the 10 patients diagnosed with IPT, 4 (40%) lacked an anatomic cause; however, these patients had a history of difficult exposure of the anterior capsule and/or a lack of capsular repair during index THA. The mean modified Harris Hip Score (mHHS) was 71.9 ± 15.6, and the mean 6-month postoperative visual analog scale (VAS) pain score was 0.8 ± 2.2, which was significantly lower than preoperatively ( = .0055). There was also significantly improved forward flexion range of motion ( = .0183) and straight leg raise (SLR) strength test results ( .0263). Hip arthroscopic surgery resulted in 8 patients (80%) continuing to be pain-free at a mean follow-up of 6.8 ± 1.4 years, while 2 patients (20%) progressed to revision arthroplasty. There were no major or minor complications.
Hip arthroscopic surgery was found to have an important role in the diagnostic and therapeutic management of patients with chronic hip pain after THA, with good clinical outcomes at a mean follow-up of 6.8 years and no complications. We believe that disruption of the anterosuperior acetabular capsule, including the reflected head of the rectus femoris, can allow the iliopsoas tendon to move intra-articularly and precipitate IPT. This disruption may be appreciated on the SLR strength test. Although this study presents a small sample size that cannot substantiate a cause-effect relationship, orthopaedic surgeons performing THA should consider minimizing disruption and/or ensuring repair of the anterior capsule to decrease this potential cause of IPT.
全髋关节置换术（THA）后慢性髋关节疼痛患者使用髋关节镜手术的相关研究在文献中较少见，大多数研究随访时间有限。
本研究的首要目标是评估髋关节镜手术在THA后慢性髋关节疼痛患者诊断和治疗中的作用。第二个目标是描述一种涉及前关节囊破裂的髂腰肌肌腱病（IPT）的新病因。
病例系列；证据等级，4级。
我们对接受髋关节镜手术治疗慢性髋关节疼痛且无明确病因的THA术后患者进行了回顾性分析，前瞻性收集其临床结果。患者年龄至少18岁，最短随访时间为24个月。
回顾性分析发现，髋关节镜手术为8例患者（80%）带来了新的诊断信息。在10例诊断为IPT的患者中，4例（40%）缺乏解剖学病因；然而，这些患者在初次THA时有前关节囊暴露困难和/或未进行关节囊修复的病史。改良Harris髋关节评分（mHHS）平均为71.9±15.6分，术后6个月视觉模拟量表（VAS）疼痛评分平均为0.8±2.2分，显著低于术前（P = 0.0055）。前屈活动范围（P = 0.0183）和直腿抬高（SLR）力量测试结果也有显著改善（P = 0.0263）。髋关节镜手术使8例患者（80%）在平均6.8±1.4年的随访中持续无痛，而2例患者（20%）进展为翻修关节置换术。无重大或轻微并发症。
髋关节镜手术在THA后慢性髋关节疼痛患者的诊断和治疗管理中具有重要作用，平均随访6.8年临床效果良好且无并发症。我们认为，包括股直肌反折头在内的髋臼前上关节囊破裂可使髂腰肌肌腱在关节内移动并引发IPT。这种破裂在SLR力量测试中可能会被发现。尽管本研究样本量较小，无法证实因果关系，但进行THA的骨科医生应考虑尽量减少对前关节囊的破坏和/或确保其修复，以减少IPT的这种潜在病因。
